Background

At Denver Health, scores on the Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) survey were lower than desired, according to Kim Indovina, MD,
ACP Member, an academic hospitalist at Denver Health and an assistant professor of
medicine at the University of Colorado. These scores affected patient satisfaction-related
incentives and penalties but, more importantly, reflected the patients' perspective
of their hospital stays, she said.

In 2013, hospitalist program leaders began to look at how to improve patient satisfaction.
When they surveyed hospitalists, they found that the clinicians were unaware of their
patient experience scores but were interested in receiving ongoing feedback, Dr. Indovina
said. “At the time, we didn't have a mechanism to provide our group with this
type of feedback in real-time,” she said. “We had our HCAHPS scores,
but these came from surveys that were typically done as long as 6 weeks after a patient's
hospital stay.”

To address this, she and her colleagues developed a new method for tracking patient
satisfaction and presented the results at Hospital Medicine 2015 in National Harbor,
Md., last spring.

How it works

Patients on hospitalist services assessed how their clinicians were doing at listening
to them, explaining what they wanted to know, and being friendly and helpful. Patients
were surveyed once daily for up to 4 consecutive days until they were discharged,
met exclusion criteria, or were fully satisfied, giving the highest possible (or “top-box”)
scores for all 3 questions.

A total of 455 patients were randomized to either a control group (n=227) or an intervention group (n=228). Feedback from the latter was sent to the hospitalist caring for each patient
on the same day of the survey. Hospitalists in the intervention arm were coached on
the importance of patient satisfaction and on etiquette-based communication and were
asked to revisit patients to address any concerns, whereas those in the control group
received no feedback or coaching.

The patients' satisfaction scores didn't always correlate with what the hospitalists
expected they would report, Dr. Indovina said. “One of the things that was
striking to me was that, when we gave this real-time survey feedback to the hospitalists,
a lot of times people were surprised at which of their patients were satisfied, and
which were not,” she said. “We may not be as good at subjectively gauging
who's happy and who's not with their experience in our hospital, without actually
asking the questions.”

Results

The research found that patient satisfaction generally improved from the first day
of hospitalization to the last, but there was little difference between intervention
and control groups. The physicians' effort did show more effect in the 65 patients
from the study (30 intervention, 35 control) who ended up taking the HCAHPS surveys.
A higher proportion of intervention patients reported top-box scores for doctors'
listening, communication, and respect: 90%, 80%, and 93% of intervention patients
versus 83%, 77%, and 86% of controls, respectively.

Using HCAHPS percentile rankings from 2013, the researchers found that responses from
patients in the control group would have put the hospital in the 10th percentile of
patient satisfaction, whereas those in the intervention group would have ranked it
in the 75th percentile, Dr. Indovina said. “While we didn't see a significant
improvement in the daily scores, the percentile differences in the HCAHPS scores were
substantial,” she said

How patients benefit

The research team asked patients for open-ended responses, and many commented about
how their physicians were improving, according to Dr. Indovina. “Patients were
pretty on board with this and seemed to think that it was a good way to have their
voices heard and comment about [their care] in real time,” she said.

Challenges

Some physicians were more leery of the system, Dr. Indovina said. “There was
a little bit of resistance, of course, to getting ‘scored’ in real-time,
but I think most people really liked having that immediate feedback and the opportunity
to do service recovery during the hospital stay, rather than hear about issues days
to months later,” she noted.

Next steps

Dr. Indovina and her team plan to launch a similar, ongoing survey tool on a medical/surgical
unit at Denver Health and ultimately implement the system throughout the hospital,
using tablet and email systems.

Words of wisdom

“Of course, the priority is to improve patient experience for the patient,
but if we can in the process improve our scores, then that certainly benefits our
hospital, as well,” said Dr. Indovina.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.